ATI RN
RN Pediatric Nursing 2023 ATI
1. A healthcare professional is assessing a child who has nephrotic syndrome. Which of the following findings should the healthcare professional expect?
- A. Hypotension
- B. Hyperglycemia
- C. Facial edema
- D. Weight gain
Correct answer: D
Rationale: In nephrotic syndrome, there is increased permeability of the glomerular filtration barrier, leading to protein loss in the urine. This results in hypoalbuminemia, causing fluid retention and edema. Therefore, weight gain due to fluid retention is a common finding in children with nephrotic syndrome.
2. When planning care for a newborn with esophageal atresia and tracheoesophageal fistula, which is the priority nursing diagnosis?
- A. Ineffective Tissue Perfusion
- B. Ineffective Infant Feeding Pattern
- C. Acute Pain
- D. Risk for Aspiration
Correct answer: D
Rationale: The priority nursing diagnosis for a newborn with esophageal atresia and tracheoesophageal fistula is 'Risk for Aspiration' because of the potential respiratory complications associated with these conditions. The newborn is at a higher risk of aspirating oral or gastric contents due to the abnormal connections between the esophagus and trachea, posing a serious threat to the airway and lungs. Addressing this risk is crucial to prevent respiratory distress and maintain the airway's patency, making it the priority nursing diagnosis in this scenario. 'Ineffective Tissue Perfusion' is not the priority as respiratory compromise takes precedence over perfusion concerns. 'Ineffective Infant Feeding Pattern' may be relevant but addressing the risk of aspiration is more critical. 'Acute Pain' is not the priority compared to the life-threatening risk of aspiration.
3. A healthcare professional is assessing an infant who has heart failure. Which of the following findings should the healthcare professional expect?
- A. Weight gain
- B. Bounding pulses
- C. Hyperactivity
- D. Increased urine output
Correct answer: A
Rationale: In infants with heart failure, one of the key manifestations is weight gain due to fluid retention. The heart's inability to pump effectively can lead to fluid buildup in the body, causing weight gain. Bounding pulses, hyperactivity, and increased urine output are not typically associated with heart failure in infants. Bounding pulses are associated with conditions like aortic regurgitation, hyperactivity can be a sign of other issues, and increased urine output is not a common finding in heart failure.
4. A school-age child has peripheral edema. Which of the following assessments should the nurse perform to confirm peripheral edema?
- A. Palpate the dorsum of the child's feet
- B. Weigh the child daily using the same scale
- C. Assess the child's skin turgor
- D. Observe the child for periorbital swelling
Correct answer: A
Rationale: To confirm peripheral edema in a child, the nurse should palpate the dorsum of the child's feet by pressing a fingertip against a bony prominence for 5 seconds. This assessment helps detect the presence of pitting edema, which is characterized by an indentation that remains after the pressure is released.
5. A caregiver is teaching a parent of a child with a new prescription for ferrous sulfate tablets. Which of the following instructions should the caregiver include in the teaching?
- A. Give the medication with milk.
- B. Take the medication on an empty stomach.
- C. Avoid giving the medication with orange juice.
- D. Brush the child's teeth after administration.
Correct answer: D
Rationale: It is important for the caregiver to instruct the parent to brush the child's teeth after administering ferrous sulfate to prevent staining of the teeth. Iron in ferrous sulfate can cause teeth discoloration, so brushing the child's teeth after taking the medication helps prevent this side effect.
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